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�.J .,
<br /> " MUKILTEO WATER DISTRICT
<br /> -,�`'; - SNOHOMISH COUNTY WASHINGTON � �
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<br /> APPLICAT!ON FOR WATER "'� (
<br /> � \ lpplicaiionNo. ��--- , � No�`7S. —^40%1'p ` �,.�
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<br />�r�� , MeterSize �`T NumberofUr.its � AccountNo. /1?S.?���,y,T-� ,
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<br /> I hereby apply for water serv�ce and agree to be governed in accordance with the resolutions, rules and regulations of the
<br /> � MU�{ILTEO WP;TER DISTRICT peRaining to water service, now or hereafter in ei`ect. The undersigned as owner or
<br /> �cr;�;•_r�ative oi the herein-described premises hereby agrees as follows:
<br /> „ (') '"tiat the cost of any extension of the water service,renewal, replacement or repair to reach and scrve ihe properry described shall be borrie
<br /> ` � by myself cr�ss'ans as crvner(s) of the premises.
<br />> ��.�, (2) That all pipes,water measuring devices and otherconnecting eGuipmenS upstream Irom the metersha I,afler!heir installation,be and become �� ''"�
<br /> S-:y �he pmperry nf the "AUKILTEO VlATER �ISTRICT, subject to all its regulations pertoining to water servico. '�
<br />�k� 3) -hat aftcr installation,if ineteror meter box and appunence.aro buried ordamaged,the ownar,will be held responsihle and charged for same.
<br /> (a) Tha;the MUKILTEG WA7ER DISTf�ICT,its olficcrs and agents,shall havo tho ri�ht ol ingrr,ss and egress lo go upon the nremises and p�opere�
<br /> described herein tor tne purpose af inspectior.,connaciing ar disconnecting ihe serviee cr for such othcr puryoses as the service may reGuire.
<br />� �ti II i,also understcod auring Ihe time ihat any of the watermains may he out ol servica by wason of any cmergency or irnpmvemenh.,authorized
<br /> �. by��TRICT,in any street or other bcation in which ihey may have heen laid,ihe DISTRICT will nnt be required ro furnish water during
<br /> the �ss ol such improvements to any censumor whase supply may thus be cut olf,or 6e liahle lor any damanns for its faili�•.:to do sc.
<br /> ' (,) Tha e DISTRICTshall have the nght to chnrge the rates atany time by Resolution,lo temoormily disconiinue the service m consumers,and
<br />:s..� toinst:llthemeter(s) Iore9isrorihewatercon;umed. TheDISTRiCTshallnotbeheldliz!�lefordamagehywat^rorothercauseresultinglrom
<br />''�"" defective lumbin ora 6ancesfstalledb theowneroroccu ontonthe remisessu h�dwithwater,andthefoctihatagentsoftheDISTFICT �
<br /> i :� P 9 PP Y P P PP�� *
<br />�'ui `. may havc inspec;ed the plumbing and apptian shall nol be plead as a basis for recovery in case of damagn as afores�id. If the suoply ot �
<br /> }"', watershallfailorbeinterruptedbyreasonotaccider., wpressumorothercausewhatsoever,theDISTFICTsh.allncl6eheidliahlelordamages
<br /> �rr> nor;hall such taiWre dFintermption forany roas ahlo timclSb heklto constitute a hreach of coMract cn;ho partof;he DISTRICTor m any•Nay �
<br /> � y� . relieve tho.cansumer,whether tenant orpw �Y,"fmm pedoiminQtfio ohligation al such tewnCs o;owner's conVact. Water shall be used hy
<br /> } �I � ( , aFplicant only on thc premises d�cri�'ed' erein. A�ew application shall he filed;houlC water be desired for other premises aithaugh IccaL_d
<br /> i�.s! �I an land deseribed hcrun ,�" -�� �� 1
<br /> ���;' , � � �y(G) That the DISTRICT recommends instaliatlon af a pressuro regula�tng valve. Appiiwnl acknowledges inlormatlon as to the ��
<br /> c .y�,
<br /> '; �^ recommridntion and assumes lull responsihili�y lar I�Ia�ip6 or faillnc�ta install a pressurc regulating value on the woter system�o �
<br /> ` pmtec�it from high pressarc.
<br />� �(7) The DISTRICT utilizes check valves at the meler lo.pre�vent water reWming to �he Districts mains. The DISTRICT recomn�onds �
<br /> � inslallationo(athermalexpansiontankto�prwentex�vGopressute6ulld•upcausedhythewa�enc�atueApplicantsacknor•Icdges �f
<br /> � ) inlormatlan as ta the recommendaUc�and assumes full responsibilty lar installing or Iailing lo Inslall a thermal expansian tank. "��
<br /> "'` � SERVICG AD�RESS %�d�/ 9 .� �. i ��LOT NQ _ I BLOCK � l .
<br /> a.. . r � ' PLAT NAME: //� ✓t wCGL- 1 � I
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<br />��,� � GTY/STATE/ZIP: i/ ���' �s �� � . ' �tEGAL DESCF�'TION: � � .w� . � �_ ! �
<br /> OWNeR'S NAME: �O �' � // ( �j��/ �
<br /> 5 c��;�� OWNER'S ADDRESS: � �t1z� �d � Mr _ 31��67� � �.
<br /> ._•; arvisrnr�ziP;��f_'� S,7`1�..w� '11�A- . 9t�3 1'�C� 4.
<br /> �"�� � � .
<br /> The premises are to be used as a / • _ /� � �' �
<br /> �s _��,li*•'�i�.�!'i �' .t iY
<br /> .�'���� INFORMATION LETIER-GAVE/SENT: 1� /� __
<br /> ` ',+ /✓
<br /> ,�; - ; CHARGES
<br /> (1)Service instaliction& conneaion charge S ��/�-y `^� � pn.1.D
<br /> � (2)Geneml Facilities connection chargo 5 ��� /� L� .
<br /> FEB 2 3 1995 K,:
<br /> �s�oin�r S q;
<br /> Tatal amoum receivcd with application S ���� ' � � MUKILTEO WAiER DISiRICi
<br /> IT IS UNDERSTCOD ihat ihis Application,althou9h signed,shall not ho binding upon�ho�V�UKILTEO WATER DISTRICT until appmved b ihc DISTRICT. �
<br />���� � �� �� � ��,
<br />� i I, ihe undersigned,owner(ar represent�tive)of ihe propeny descn�d�boW,do hereby mako applicatian for install�.ion ef a � -inch i ` �
<br /> �� di�meter water s�pply service connecCon � c �in appurtenances,and,all neces ahor atmy expenses. � ."
<br />��"�I Datedihis -'� dayof � - '� . -r�--�-%a � ' ,1�• �� �\ �
<br /> �
<br /> I APPLICAWTS SIGNATURE: ' �'� . ��� ' I J' ' � ' . , �
<br />;� �F . Appiicant's Namo (please print): ��'�'¢ ) �1 �'� vc 3��i6 _ ' ' ��
<br />� � ` ..� �FFlicanCs Addresc and Phono �Jumbar._{ � ���J�1 !.��'�� ��'�� . �
<br />� � r!t-�C:.�: �.� �-t-�`a� �r/,�� /'Q�3 �_
<br /> � APPROVED; -� °' , a
<br /> �' M� WATER DISTRICT
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